Extrapolation of the evidence on teratogenicity of chemicals between humans and experimental animals: chemicals other than drugs

An Overview of the U.S. EPA Proposed Amendments to the Guidelines for the Health Assessment of Suspect Developmental Toxicants

The U.S. Environmental Protection Agency has recently proposed amendments to the Guidelines for the Health Assessment of Suspect Developmental Toxicants. These amendments expand and clarify points made in the original guidelines, and add new information based on advances in the field. For example, the original risk assessment guidance was developed around several basic assumptions that were implicit in the earlier document, but that are clearly stated in the proposed amendments. Also, several consensus workshops were held following the completion of the 1986 guidelines, and the conclusions of these workshops have been incorporated. These include workshops dealing with the relationship of maternal and developmental toxicity, and with the development of an approach for a weight-of-evidence classification. In addition, a reference dose for developmental toxicity (RfDT) is proposed, based on short-term exposure, to distinguish it from the Rf D for chronic exposure. Other proposed changes include the expansion of the functional developmental toxicity section to reflect the Agency's testing guidelines for developmental neurotoxicity, and the human studies section which now gives more guidance on the use of human data in risk assessment. A number of other minor proposed changes are discussed. The final amended guidelines are currently undergoing Agency review and should be completed within the next year.

A Retrospective Appraisal of the Ability of Animal Tests To Predict Reproductive and Developmental Toxicity in Humans

The reproductive and developmental toxicology areas have undergone numerous changes in the 30 years since the thalidomide tragedy. It would be comforting if such changes have resulted in a greatly decreased likelihood that human conceptuses will develop malformations. However, there is little evidence that such testing has better enabled us to identify human reproductive or developmental toxicants. Although there may be justification for performing animal testing on drugs and pesticides, a simple acute toxicity test may be just as predictive as currently employed reproductive and developmental toxicity tests for other synthetic chemicals. Support for this premise is provided by comparing available acute toxicity information on many compounds, identified as (potential) human developmental or reproductive toxicants, with their respective likely human threshold doses. Acute LD50 values of other potential human reproductive or developmental toxicants, not documented as being a threat to humans, also were compared with their time-weighted averages or their lowest teratogenic dose in the same species. The data generated support the premise that most reproductive or developmental toxicants are a potential threat to humans only if exposure levels approach those that are lethal in the rat or mouse. In contrast, unequivocal evidence of developmental toxicity for drugs, such as thalidomide and isotretinoin, to which the human embryo is highly sensitive, were not apparent in the screens used now for routine developmental toxicology testing. Thus, requirements that all chemicals be tested for reproductive and developmental toxicity should await the development of testing methodology capable of better assessing human risk.

Counseling patients on preventing prenatal environmental exposures--a mixed-methods study of obstetricians

OBJECTIVE

Describe the attitudes, beliefs, and practices of U.S. obstetricians on the topic of prenatal environmental exposures.

STUDY DESIGN

A national online survey of American Congress of Obstetricians and Gynecologists (ACOG) fellows and 3 focus groups of obstetricians.

RESULTS

We received 2,514 eligible survey responses, for a response rate of 14%. The majority (78%) of obstetricians agreed that they can reduce patient exposures to environmental health hazards by counseling patients; but 50% reported that they rarely take an environmental health history; less than 20% reported routinely asking about environmental exposures commonly found in pregnant women in the U.S.; and only 1 in 15 reported any training on the topic. Barriers to counseling included: a lack of knowledge of and uncertainty about the evidence; concerns that patients lack the capacity to reduce harmful exposures; and fear of causing anxiety among patients.

CONCLUSION

U.S. obstetricians in our study recognized the potential impact of the environment on reproductive health, and the role that physicians could play in prevention, but reported numerous barriers to counseling patients. Medical education and training, evidence-based guidelines, and tools for communicating risks to patients are needed to support the clinical role in preventing environmental exposures that threaten patient health.

Bridging epidemiology and model organisms to increase understanding of endocrine disrupting chemicals and human health effects

Concerning temporal trends in human reproductive health has prompted concern about the role of environmentally mediated risk factors. The population is exposed to chemicals present in air, water, food and in a variety of consumer and personal care products, subsequently multiple chemicals are found human populations around the globe. Recent reviews find that endocrine disrupting chemicals (EDCs) can adversely affect reproductive and developmental health. However, there are still many knowledge gaps. This paper reviews some of the key scientific concepts relevant to integrating information from human epidemiologic and model organisms to understand the relationship between EDC exposure and adverse human health effects. Additionally, areas of new insights which influence the interpretation of the science are briefly reviewed, including: enhanced understanding of toxicity pathways; importance of timing of exposure; contribution of multiple chemical exposures; and low dose effects. Two cases are presented, thyroid disrupting chemicals and anti-androgens chemicals, which illustrate how our knowledge of the relationship between EDCs and adverse human health effects is strengthened and data gaps reduced when we integrate findings from animal and human studies.

Hazard identification and predictability of children's health risk from animal data

Children differ from adults both physiologically and behaviorally. These differences can affect how and when exposures to xenobiotics occur and the resulting responses. Testing using animal models may be used to predict whether children display novel toxicities not observed in adults or whether children are more or less sensitive to known toxicities. Historically, evaluation of developmental toxicity has focused on gestational exposures and morphological changes resulting from this exposure. Functional consequences of gestational exposure and postnatal exposure have not been as well studied. Difficulties with postnatal toxicity evaluations include divergent differentiation of structure, function and physiology across species, lack of understanding of species differences in functional ontogeny, and lack of common end points and milestones across species.

Differential sensitivity of children and adults to chemical toxicity. II. Risk and regulation

Animals can be useful predictors of chemical hazards to humans. Growth and development are compressed into a shorter period in animals, which makes interpretation of animal testing inherently more difficult. However, similar events occur in both humans and laboratory animals and testing that covers the full period of animal development can reasonably be considered an appropriate surrogate for human development. Some have proposed an additional 10-fold factor for the extra protection of children when estimating safe exposures. Use of such an additional factor, as required by the Food Quality Protection Act (FQPA), is meant to address the same issues covered by the EPA's database uncertainty factor, UF(D), and additional issues related to exposure uncertainty. Thus, when UF(D) has already been deployed, the EPA modifies its use of the FQPA factor. Based on our analysis, we agree with the EPA. Drawing conclusions about the adequacy of UF(H), the uncertainty factor used to account for intrahuman variability, in terms of its ability to protect children on the basis of the modest data available is challenging. However, virtually all studies available suggest that a high percentage of the population, including children, is protected by using a 10-fold uncertainty factor for human variability or by using a 3.16-fold factor each for toxicokinetic and toxicodynamic variability. Based on specific comparisons for newborns, infants, children, adults, and those with severe disease, the population protected is between 60 and 100%, with the studies in larger populations that include sensitive individuals suggesting that the value is closer to 100%.

Appropriate use of animal models in the assessment of risk during prenatal development: an illustration using inorganic arsenic

BACKGROUND

Assessing risks to human development from chemical exposure typically requires integrating findings from laboratory animal and human studies.

METHODS

Using a case study approach, we present a program designed to assess the risk of the occurrence of malformations from inorganic arsenic exposure. We discuss how epidemiological data should be evaluated for quality and criteria for determining whether an association is causal. In this case study, adequate epidemiological data were not available for evaluating the potential effect of arsenic on development. Consequently, results from appropriately designed, conducted, and interpreted developmental toxicity studies, which have been shown to be predictive of human risk under numerous scenarios, were used. In our case study, the existing animal data were not designed appropriately to assess risk from environmental exposures, although such studies may be useful for hazard identification. Because the human and animal databases were deficient, a research program comprising modern guideline toxicological studies was designed and conducted.

RESULTS

The results of those studies in rats, mice, and rabbits indicate that oral and inhalational exposures to inorganic arsenic do not cause structural malformations, and inhalational exposures produced no developmental effects at all. The new study results are discussed in conjunction with considerations of metabolism, toxicokinetics, and maternal toxicity.

CONCLUSIONS

Based on the available experimental data, and absent contrary findings from adequately conducted epidemiological studies, we conclude that exposure to inorganic arsenic by environmentally relevant routes poses no risk of the occurrence of malformations and little risk of other prenatal developmental toxicity in developing humans without concomitant and near-lethal toxicological effects in mothers.

An assessment of the developmental toxicity of inorganic arsenic

A critical analysis of the literature base regarding the reproductive and developmental toxicity of arsenic compounds, with emphasis on inorganic arsenicals, was conducted. The analysis was stimulated by the great number of papers that have purported to have shown an association between exposure of pregnant laboratory animals to arsenic compounds and the occurrence of offspring with cranial neural tube defects, particularly exencephaly. For the most part, the literature reports of arsenic developmental toxicity in experimental animals are inadequate for human risk assessment purposes. Despite the shortcomings of the experimental database, several conclusions are readily apparent when the animal studies are viewed collectively. First, cranial neural tube defects are induced in rodents only when arsenic exposure has occurred early in gestation (on Days 7 [hamster, mouse], 8 [mouse], or 9 [rat]). Second, arsenic exposures that cause cranial neural tube defects are single doses that are so high as to be lethal (or nearly so) to the pregnant animal. Third, the effective routes of exposure are by injection directly into the venous system or the peritoneal cavity; even massive oral exposures do not cause increases in the incidence of total gross malformations. Fourth, repetition of similar study designs employing exaggerated parenteral doses is the source of the large number of papers reporting neural tube defects associated with prenatal arsenic exposure. Fifth, in five repeated dose studies carried out following EPA Guidelines for assessing developmental toxicity, arsenic was not teratogenic in rats (AsIII, 101 micromol/kg/d, oral gavage; 101 micromol/m3, inhalation), mice (AsV, 338 micromol/kg/d, oral gavage; est. 402 micromol/kg/d, diet), or rabbits (AsV, 21 micromol/kg/d, oral gavage). Data regarding arsenic exposure and adverse outcomes of pregnancy in humans are limited to several ecologic epidemiology studies of drinking water, airborne dusts, and smelter environs. These studies failed to (1) obtain accurate measurements of maternal exposure during the critical period of organogenesis and (2) control for recognized confounders. The lone study that examined maternal arsenic exposure during pregnancy and the presence of neural tube defects in progeny failed to confirm a relationship between the two. It is concluded that under environmentally relevant exposure scenarios (e.g., 100 ppm in soil), inorganic arsenic is unlikely to pose a risk to pregnant women and their offspring.

Genetic toxicities of human teratogens

Birth defects cause a myriad of societal problems and place tremendous anguish on the affected individual and his or her family. Current estimates categorize about 3% of all newborn infants as having some form of birth defect or congenital anomaly. As more precise means of detecting subtle anomalies become available this estimate, no doubt, will increase. Even though birth defects have been observed in newborns throughout history, our knowledge about the causes and mechanisms through which these defects are manifested is limited. For example, it has been estimated that around 20% of all birth defects are due to gene mutations, 5-10% to chromosomal abnormalities, and another 5-10% to exposure to a known teratogenic agent or maternal factor [D.A. Beckman, R.L. Brent, Mechanisms of teratogenesis. Ann. Rev. Pharmacol. Toxicol. 24 (1984) 483-500; K. Nelson, L.B. Holmes Malformations due to presumed spontaneous mutations in newborn infants, N. Engl. J. Med. 320 (1989) 19-23.]. Together, these percentages account for only 30-40%, leaving the etiology of more than half of all human birth defects unexplained. It has been speculated that environmental factors account for no more than one-tenth of all congenital anomalies [D.A. Beckman, R.L. Brent, Mechanisms of teratogenesis, Ann. Rev. Pharmacol. Toxicol. 24 (1984) 483-500]. Furthermore, since there is no evidence in humans that the exposure of an individual to any mutagen measurably increases the risk of congenital anomalies in his or her offspring' [J.F. Crow, C. Denniston, Mutation in human populations, Adv. Human Genet. 14 (1985) 59-121; J.M. Friedman, J.E. Polifka, Teratogenic Effects of Drugs: A Resource for Clinicians (TERIS). The John Hopkins University Press, Baltimore, 1994], the mutagenic activity of environmental agents and drugs as a factor in teratogenesis has been given very little attention. Epigenetic activity has also been given only limited consideration as a mechanism for teratogenesis. As new molecular methods are developed for assessing processes associated with teratogenesis, especially those with a genetic or an epigenetic basis, additional environmental factors may be identified. These are especially important because they are potentially preventable. This paper examines the relationships between chemicals identified as human teratogens (agents that cause birth defects) and their mutagenic activity as evaluated in one or more of the established short-term bioassays currently used to measure such damage. Those agents lacking mutagenic activity but with published evidence that they may otherwise alter the expressions or regulate interactions of the genetic material, i.e. exhibit epigenetic activity, have likewise been identified. The information used in making these comparisons comes from the published literature as well as from unpublished data of the U.S. National Toxicology Program (NTP).

Occupational Exposures and Risks of Spontaneous Abortion among Female Veterinarians

Associations between occupational exposures and spontaneous abortion (SA) in a cohort of female veterinarians were studied with pregnancy and job-exposure history data collected as part of a mixed-mode survey of all women graduating from U.S. veterinary colleges during the 11-year period 1970-1980 (N = 2,997; response rate 85.0%). Data analysis focused on SA risks among postgraduation pregnancies in relation to 1) type of clinical practice at the time of conception and 2) self-reported occupational exposures to 13 exposure entities. Multiple logistic regression was used to control for the potentially confounding effects of maternal age, gravidity, previous SA, and smoking and drinking behaviors. Pregnancies reported by veterinarians employed in all-equine practices were at highest relative risk of spontaneous abortion when compared with pregnancies reported by unemployed veterinarians [confounder-adjusted odds ratio (aOR) = 2.1; 95% confidence interval (CI), 0.6-7.4]. Agent-specific relative risk estimates ranged from 0.7 to 1.1, suggesting little or no excess risk. However, when analyses were restricted to small-animal practitioners, there was a weak association between SA risk and job-related exposure to ionizing radiation (aOR equals; 1.3; 95% CI, 0.8-2.0), a finding not inconsistent with the results of two other studies of female veterinarians. Although this study showed no strong associations, the results suggest a relationship between SA among female veterinarians and certain exposure types, and thus focus attention on other workers who encounter similar on-the-job hazards.

Mutagenic lifestyles? A review of evidence of associations between germ-cell mutations in humans and smoking, alcohol consumption and use of 'recreational' drugs

In humans, associations between germ-cell mutations and hypothetical aetiological factors can be investigated by (1) examining the relationship between the factor of interest and conditions known to be of genetic aetiology; (2) examining the relationship between conditions of unknown aetiology and route of exposure, especially paternal preconceptional exposure. As regards smoking, alcohol and 'recreational' drugs, the first approach has been applied in studies of retinoblastoma, Wilms' tumour and chromosomal anomalies. Only Down's syndrome has received intensive investigation, in relation to maternal smoking during pregnancy; the relative risks would be compatible with there being no association in all recognized conceptuses. The second approach has been applied in studies of sperm quality, miscarriage, congenital anomalies and childhood cancer. The available studies do not show a consistent relationship between smoking and sperm quality; there are few data on the effects of the other exposures. There are a substantial number of studies of childhood cancer and smoking by the father; the majority do not indicate any relationship. Some studies of childhood cancer suggest a positive association with use of 'recreational' drugs by the parents, but it has not been possible to clarify which route of exposure, or the specific type of drug which may be involved. Use of molecular techniques to detect individual genetic changes should enable progress to be made in elucidating the origin of mutation. In the meantime, public health actions are justified on the basis of the known non-genetic effects of these agents.

Pathophysiology and treatment of carbon monoxide poisoning

Carbon monoxide poisoning is the leading cause of poisoning deaths in the US, and published reports of carbon monoxide related morbidity and mortality can vary widely. Common morbidity involves myocardial and/or neurologic injury including delayed neurologic sequelae. The pathophysiology of this entity is complex, involving hypoxic stress on the basis of interference with oxygen transport to the cells and possibly impairing electron transport. Carbon monoxide can also affect leukocytes, platelets and the endothelium, inducing a cascade of effects resulting in oxidative injury. Carboxyhemoglobin levels are valuable for confirming carbon monoxide exposure but cannot be used to stratify severity of poisoning, predict prognosis, or indicate a specific treatment plan. Oxygen therapy is the key treatment of carbon monoxide intoxication, and hyperbaric oxygen has been shown to interdict and improve clinical outcome in some patients. Immediate treatment with a high fraction of inspired oxygen and careful clinical evaluation are mandatory. Timely referral for hyperbaric oxygen is indicated for patients with any history of unconsciousness, cardiovascular instability or ischemia, and persistent mental and/or neurologic deficits. Hyperbaric oxygen should also be considered in certain other patient subsets.

Risk factors for coarctation of the aorta

To test the hypothesis that environmental factors during early pregnancy may cause coarctation of the aorta (CoA), 50 cases of CoA and 756 controls were studied. The cases represented all verified CoAs in Finland during 1982-1983 and controls were randomly selected from all babies born during the same period. Both case and control mothers were interviewed by midwives approximately 3 months after delivery. In these data 18 patients had pure CoA only and the remaining 32 at least one other cardiac anomaly. Three CoA patients had a chromosomal anomaly. The relatives of CoA babies had more congenital anomalies than those of the control babies. Maternal overall exposure to chemicals at work was slightly more prevalent among the CoA group (32.0%) than the control group (26.2%). Maternal exposure to mineral oil products at work during early pregnancy was more common among CoA cases (8.0%) than controls (1.4%) [odds ratio (OR) = 5.9, 95% confidence interval (CI95) = 1.8-19.2]. The risk of CoA was also associated with previous miscarriages (OR = 2.3, CI95 = 1.2-4.4) and twin birth (OR = 16.3, CI95 = 4.0-67) of the child. The risk of CoA was not associated with seasonal variation, maternal smoking, alcohol consumption, or use of deodorants. It is concluded that genetic factors explain only a small fraction of the causes of CoA and that many common environmental exposures during early pregnancy are unlikely to be real risk factors for CoA. However, the power of this study was weak for testing the teratogenicity of specific chemicals.

Occupational risk factors for congenital heart disease

To investigate possible associations between cardiovascular malformations and maternal occupational exposure to various factors during the first trimester of pregnancy, 406 cases and 756 controls were studied retrospectively. The cases were taken from all infants diagnosed with cardiovascular malformations born in Finland during 1982 and 1983. The controls were randomly selected from all normal births in the country during the same period. All mothers were interviewed approximately 3 months after delivery by a midwife, using a structured questionnaire. Maternal overall exposure to chemicals at work was more prevalent among the case group (35.8%) than the control group (26.2%, P less than 0.01). Among the specific chemical groups, maternal exposure to dyes, lacquers, or paints was significantly associated with the risk of congenital heart disease. Exposure to organic solvents during the first trimester seemed to increase to risk of ventricular septal defect (P less than 0.05). Work at video display terminals was slightly more prevalent among the case group (6.3%) than among the control group (5.0%). The mothers' education level, regular exposure to passive smoking at work, or temperature at the workplace were not risk factors for congenital heart disease in the offspring, neither was maternal exposure to microwave ovens, disinfectants, pesticides, or anesthetic gases. It is concluded that many maternal exposures at work seem not to have a teratogenic effect on the fetal heart, although the limited power of this investigation needs to be borne in mind.

Prioritizing candidate reproductive/developmental toxicants for evaluation

To provide a rational method for the timely evaluation of possible reproductive/developmental toxicants, a prioritization scheme was developed by the California Department of Health Services to select chemicals for consideration by the Proposition 65 Scientific Advisory Panel. Initially, four ascertainment methods were used to identify and construct a master list of 164 candidate agents. Using two criteria, the potential for human exposure and the perceived reproductive/developmental hazard as judged by an ad hoc committee of experts, 42 candidates from the master list were identified as priority agents. For practical purposes, the 15 priority agents with the highest rankings will be given the highest priority in the review process. Limitations in the prioritization method used and refinements to be incorporated in an annual update are described.

Genotoxic, carcinogenic, and teratogenic hazards in the marine environment, with special reference to the Mediterranean Sea

Genotoxic, carcinogenic, and teratogenic hazards arising out of pollution in the marine environment are discussed in this article, with special reference to the situation in the Mediterranean area. A number of chemical compounds or complex mixtures relevant to marine pollution, either natural or of anthropogenic origin, are tentatively listed, along with protective factors which may play a counteracting role in the same environment. Harmful substances tend to undergo interactions and transformations in seawater, sediments, and marine biota, due to physical, chemical, microbial, or light-mediated mechanisms. Bioaccumulation phenomena in marine organisms may result from food-chain biomagnification processes or from concentration of pollutants by filter feeders. A variety of sources can account for marine pollution by genotoxic, carcinogenic, and teratogenic compounds, but there is a relative paucity of analytical data concerning the Mediterranean. Metabolic transformations of xenobiotics occur in all marine organisms, the biochemical mechanisms in fish being comparable to those which have been extensively investigated in mammals. Induction of metabolic pathways, and especially of the mixed-function oxygenase system, represents the earliest warning signal of exposure to pollutants. Occurrence of neoplastic diseases is documented by experimental and field studies in marine vertebrates as well as in invertebrates. The association with local pollution phenomena has been recognized in several studies, but other etiopathogenetic factors may be also involved, and in some cases tumors have been reported to be unrelated to chemical pollution. Genotoxic agents have been detected by means of suitable techniques in seawater, sediments, and marine organisms. Several studies have investigated the presence of carcinogen-DNA adducts, DNA damage and repair processes, and cytogenetic alterations, such as chromosomal aberrations, sister-chromatid exchanges, and micronuclei, in tissues of marine organisms. However, monitoring of these end-points under field conditions encounters some limitations and problems. Even more fragmentary is the information on teratogenic effects in marine organisms, although interesting test systems have been set up. On the whole, a quite extensive database on all these toxicological issues is already available in the literature, but further studies are warranted for an adequate assessment of genotoxic, carcinogenic, and teratogenic hazards, and possibly counteracting factors in the marine environment, and specifically in the Mediterranean Sea.

Maternal exposure to chemical and physical factors during pregnancy and cardiovascular malformations in the offspring

The possible effect of chemical and physical factors during pregnancy on the occurrence of cardiovascular malformations in the offspring was studied in 573 cases and 1,055 controls. The cases represented all verified cardiovascular malformations in Finland during 1982-1984. The controls were randomly selected from all babies born during the same period. Case and control mothers were interviewed by midwives approximately 3 months after delivery using a structured questionnaire. Maternal alcohol consumption during the first trimester of pregnancy was more common among the mothers of case infants (45.9%) than those of controls (39.6%). Exposure to organic solvents at work was slightly more prevalent among the ventricular septal defect group (12.1%) than the control mothers (7.8%). However, neither association was significant when adjusted for maternal age in logistic regression analysis. Moreover, one or both of these associations may be chance effects resulting from multiple comparisons. The risk of cardiovascular malformations was not associated with maternal smoking, or coffee, tea, or cola consumption, and was equal in urban and rural areas. Maternal exposures to anesthetic gases, pesticides, wood preservatives, microwave ovens, and video display terminals at work or home were not associated with the risk of cardiovascular malformations. It is concluded that some common environmental exposures during early pregnancy to physical and chemical factors should not necessarily be considered hazardous for the developing fetal heart. The causes of the majority of cardiovascular malformations remain unknown.

Risk factors for ventricular septal defect in Finland

The possible effect of genetic and environmental factors during pregnancy on the occurrence of ventricular septal defect (VSD) in the offspring was studied in 150 cases and 756 controls. The cases represented all verified VSDs in Finland during 1982-1983. The controls were randomly selected from all babies born during the same period. Case and control mothers were interviewed by midwives approximately three months after delivery using a structured questionnaire. Congenital heart disease was more prevalent among parents of cases than those of controls. Maternal alcohol consumption during the first trimester of pregnancy was more common among the mothers of VSD infants (47.0%) than among those of controls (38.0%, P less than 0.05). Exposure to organic solvents at work showed in logistic regression analysis an adjusted relative odds ratio of 1.8 (95% confidence interval 1.0-3.4). The risk of VSD was not associated with any of the maternal habits monitored, e.g. smoking, or coffee, tea, cola, acetosalicylic acid or diazepam consumption. Whether the mother was employed during the first trimester of pregnancy, and her exposure to anesthetic gases, disinfectants, pecticides, wood preservatives or video display terminals were not factors associated with the risk of ventricular septal defect.

Regulating teratogenicity as a health risk

The development of scientific knowledge and regulatory policy with respect to teratogenicity is reviewed. The current debate on the definition of teratogenicity and on perceived risks, as illustrated by the Dutch Health Council report on teratogenicity, originates from the increased regulatory demands and from incoherent development of teratology as a scientific discipline. Barriers in the development of knowledge are discussed with respect to their consequences for regulatory policy. Special emphasis is given to behavioural effects, to the rise of monitoring and registration systems, and to epidemiological research. From a regulatory perspective, knowledge on the public perception of teratogenicity as a health risk is inadequate. It is concluded that the present situation is ambivalent and poses a real problem for regulatory policy. The positions vary from refining the original and very strict definition stressing severity and low risk, to stressing the need for a more comprehensive definition; in the latter case teratogenicity is seen as a top of the iceberg problem to be treated as part of the reproductive toxicity health issue.

Risk factors for cardiovascular malformations in Finland

The possible effects of genetic and environmental risk factors during pregnancy on the occurrence of cardiovascular malformations in the offspring was studied in 408 cases and 756 controls. The cases represented all registered cardiovascular malformations reported in Finland during 1982-1983. The controls were randomly selected from all babies born during the same period. Both the case and control mothers were interviewed by midwives approximately three months after delivery using a structured questionnaire. The parents of cases had more cardiovascular malformations than parents of the controls. Maternal alcohol consumption seemed to double the risk of atrial septal defect (OR = 1.9, CI95 1.0-3.4). Maternal exposure to dyes, lacquers or paints was a significant risk factor for conal septal defects (OR = 2.9, CI95 = 1.2-7.5). Maternal upper respiratory infection was twice as common among the hypoplastic left ventricle group as among the controls. Maternal smoking, coffee, tea and cola consumption and intake of acetylsalicylic acid were equally prevalent in both groups. Maternal exposure to anesthetic gases, wood preservatives or pesticides was not associated with the risk of cardiovascular malformations. The study confirms that very little is known of the etiology of congenital heart disease.

Occupational exposure and defects of the central nervous system in offspring: review

A study of published work was carried out in a search for evidence of a causal role for parental occupational exposure in the origin of structural and functional defects of the central nervous system (CNS) in children. Studies that consider this topic are scarce and mostly refer to broad categories of exposures and effects. Non-occupational studies referring to environmental exposure of humans and studies on experimental animals were also reviewed. The studies on animals provided straightforward evidence about morphological and behavioural abnormalities resulting from some agents used occupationally. The studies on humans yielded a scala of defects that could be ascribed to exposure to high doses of various agents in the environment. Evidence for a causal role of occupational exposure has not been found, but a highly probable influence on the developing CNS is hypothesised for lead, methyl mercury, and ionising radiation. Parental occupational exposure to cadmium, organic solvents, anaesthetics, and pesticides may also play a part in causing defects of the CNS. Well designed future research is needed to test the above hypotheses.

Cardiovascular malformations and maternal exposure to video display terminals during pregnancy

The possible effects of working with video display terminals (VDTs) during pregnancy on the occurrence of cardiovascular malformations in the offspring was studied in 500 cases and 1055 controls. The cases represented all registered cardiovascular malformations reported in Finland during 1982-84, excluding those with chromosomal anomaly or known genetic syndrome. The controls were randomly selected from all babies born during the same period. Both the case and control mothers were interviewed by midwives using a structured questionnaire approximately three months after delivery. In this interview the mother's occupation, job description and employer during the first trimester were noted, as were large number of other exposures to chemical and physical factors. An industrial hygienist examined all these records for information indicating exposure to VDTs, unaware of case/control status. Work with VDTs during the first trimester of pregnancy was ascertained for 30 case mothers (6.0%, 30/500) and 53 control mothers (5.0%, 53/1055). In logistic regression analysis maternal exposure to VDTs for at least 20h a week during the first trimester of pregnancy showed a point estimate of odds ratio of 1.4 with 95% confidence limits of 0.5 and 3.8, when adjusted for age and alcohol use. Maternal exposure to VDTs was not associated with indicators of fetal growth such as birthweight, placental weight or length of gestation.

Embryotoxic/teratogenic potential of halothane

The embryotoxic/teratogenic potential of halothane was evaluated on the basis of available data obtained in an extensive literature search. It was found that halothane induced ultrastructural visible changes in the offspring of rats exposed to concentrations of 10 ppm during gestation. These consisted of degenerative changes in the cerebral cortex and, in particular, the weakening of cell membranes and the vacuolisation of the Golgi-complex. Macroscopically visible morphological changes were seen in rats only after exposure to concentrations equivalent to 320-fold (1600 ppm) the MAK value (maximum concentration value at the workplace). Furthermore, behavioural disorders were seen when exposure to concentrations greater than or equal to 10 ppm occurred during gestation and after parturition. In mice, only macroscopical investigations were performed. The first disturbances scored were only visible as retardation in the offspring, and occurred after exposure to concentrations of halothane 200-fold (1000 ppm) the MAK-value. In the rabbit, anaesthetic concentrations of 22000 ppm halothane did not result in an embryotoxic/teratogenic effect. The individual epidemiological findings in humans were discussed controversially. The studies are inconclusive in establishing an embryotoxic/teratogenic risk following sole exposure to halothane at the MAK level, since mixed exposures occurred and data on the concentrations of halothane in the inhaled air were missing. Therefore, the decision on whether halothane can impair intrauterine development is primarily based on the animal experimental findings. As long as a threshold value has not been established for the observed lesions, halothane should not be inhaled during pregnancy.

The advisory subgroup in toxicology of the european medical research councils

The European Medical Research Councils set up an Advisory Group in Toxicology which met from 1975 to 1988. Since encouragement of cross discipline research is still difficult, a resumé is presented of the procedures developed to encourage interdisciplinary research in toxicology in Europe. A programme of grants in toxicology for collaborative research between European countries was begun in 1981 under the auspices of the European Science Foundation. Resulting from the final meeting of AST in Milan, the need for the development of links between epidemiology and molecular aspects of toxicology and for new approaches in eco-toxicology are briefly discussed.

Paternal employment in solvent related occupations and adverse pregnancy outcomes

Washington State birth certificates were examined for associations between adverse pregnancy outcomes and paternal employment in solvent exposed occupations. Four cohorts defined by live, singleton births to fathers usually employed as auto body shop workers, painters (construction and maintenance), printers, or fibreglass workers were compared retrospectively with both a systematically selected control cohort and a low solvent exposed, occupationally defined control cohort (paternal electricians). The effects of maternal race and medical illness were controlled by sample restriction; maternal age and gravidity by stratified analysis. There was evidence of increased risk of low birth weight for infants born to fathers employed as body shop workers (relative risk = 1.6; 95% confidence interval = 1.1-2.4) or painters (RR = 1.4; CI = 0.9-2.1) when compared with the systematically selected controls but not with the electrician controls. The excess risk appeared stronger when only term infants were analysed suggesting a mechanism of growth retardation rather than prematurity. There was no evidence of increased risk among the other exposed cohorts or for other adverse pregnancy outcomes. Several design features limit the interpretation of the findings and confirmation by other studies is needed.

Cardiovascular malformations and organic solvent exposure during pregnancy in Finland

In order to investigate the possible association between cardiovascular malformations and maternal exposure to organic solvents during the first trimester of pregnancy, 569 cases and 1,052 controls were retrospectively studied. The cases represented all infants with diagnosed cardiovascular malformations born in Finland in 1982-1984, and the controls were randomly selected from all normal births in the country during the same period. All mothers were interviewed approximately 3 months after delivery by a midwife using a structured questionnaire. Exposures to organic solvents at work during the first trimester of pregnancy were slightly more prevalent among the mothers of affected infants (10.4%) than among those of controls (7.8%). Logistic regression analysis of exposure to organic solvents showed an adjusted relative odds ratio of 1.3 (95% confidence interval, 0.8-2.2). In the analysis of ventricular septal defect, exposure to organic solvents showed an adjusted relative odds ratio of 1.5 (95% confidence interval, 1.0-3.7).

Assessment of the developmental risks resulting from occupational exposure to select glycol ethers within the semiconductor industry

This risk assessment evaluates the potential human hazards of adverse developmental effects posed by exposure to 2-ethoxyethanol (2-EE), 2-ethoxyethanol acetate (2-EEA), 2-methoxyethanol (2-ME), and 2-methoxyethanol acetate (2-MEA) as they are currently used in semiconductor manufacturing. These glycol ethers are contained in positive photoresists used in the wafer fabrication process. The available data on the developmental toxicology of these glycol ethers indicates that each can selectively affect the offspring of pregnant animals that have been exposed to relatively low vapor concentrations. For these chemicals, the ratio of the lowest dose which adversely affected the pregnant animals (A) and the lowest dose which produced developmental effects in offspring (D), e.g., A/D ranged from 1-5. Approximately 400 workplace air samples of 4-8 h duration, both personal and area, from seven different companies were used to assess the degree of inhalation exposure during the manufacture of wafers. The geometric mean results obtained during personal sampling of workplace air for 2-EE, 2-EEA, 2-ME, and 2-MEA were 0.36, 0.02, 0.10, and 0.01 ppm, respectively. These levels are 14- to 500-fold lower than the applicable threshold limit value (TLV) currently recommended by the American Conference of Governmental Industrial Hygienists (ACGIH). Specifically, the margins of safety between the typical occupational exposure and the TLV for 2-ME, 2-EE, 2-MEA, and 2-EEA are 50, 14, 500, and 250, respectively. The TLVs for these chemicals were set at levels considered sufficiently low to protect workers and their offspring from adverse effects and are about 2- to 10-fold lower than the various no-observed-effect levels (NOELs) obtained in animal tests. Based on more recent data, lower TLVs are indicated. The safety-factor approach, rather than mathematical models developed for estimating cancer risks, was used in this analysis. Historical data have shown that the application of safety factors of 10-100 to the NOEL, as determined in Segment II developmental toxicology tests in animals, should be adequate to protect humans. In its risk assessment guidelines, the U.S. Environmental Protection Agency (EPA) selected the uncertainty-factor approach as the most reasonable one for evaluating the hazards of developmental toxicants. This assessment indicates that the airborne concentrations of these glycol ethers in the semiconductor industry are, in general, sufficiently low to protect employees against their adverse developmental and reproductive effects as well as any other toxic effects as long as dermal exposure is minimal.